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<br /> PERMIT APPLICATION
<br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits
<br /> _�- .; , w - - _. . _ .>,� _, ._ � _ . , g„,, r r,
<br /> (Blue;or Bl,ack 1nk Onl`,�leasej, �' ` PRQ;IEGT SlTE INF#?RMATION, °;, ,�,,,f„:�.� ��4,,, -' ;����, . a H,;� '
<br /> ,7 9n. —A- x:�,�,
<br /> PROJECT SITE ADDRESS: 3ZOZ COlby AVeriUe PROPERTY TAX#: 004391'7E)HOZSOO
<br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description)
<br /> ��'a� �''J°".� t����' b IN`P� � - ' t a P iii y i�i " � ,. rar ,
<br /> ` ��z�� �i��y •,", �i,a� . ��NTACT INFORIKI(ATIDNi,� ,� »,� , � ��fi �,,: �.:,'
<br /> OWNER NAME: W1111Sffi M Sal1ffia, MD TENANT NAME(If Commercial): LabCOTp
<br /> OWNER MAILING ADDRESS: sTReer 2415 Taylor Dr
<br /> crrv Everett STATE WA ziP 98023
<br /> OWNER PHONE: 42S-E)SZ-172Z OWNER EMAIL:
<br /> CONTRACTOR .� �� _�.. _ _- �Y
<br /> _ __ _
<br /> NAME: My-Way Construction LLC
<br /> CONTRACTOR ADDRESS: sTReer 6855 176th Ave NE- Suite B-265
<br /> cirv Redmond STATE WA ZiP 980525
<br /> CONTRACTOR PHONE: ZO6-S79-S7SO CONTRACTOR EMAIL: ri11ICeri1@ri1y-W1yCOriStT'UCt10ri.COri1
<br /> CONTRACTOR LICENSE#(REQUIRED): 6O29Sgg32 CITY OF EVERETT BUSINESS LICENSE#(REQUI
<br /> PRIMARY CONTACT: ❑OWNER �I CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: MiChael Myers CONTACT PHONE: 206-579-8750
<br /> CONTACT EMAIL: TY11k0ri1�Q 1Tly-W1�'COriStT'UCt10ri.CO1T1
<br /> x � � : ,` ��'MBUILD�NG"P�RMIT,A�L1C/�T�ON . �� �' `` �
<br /> ������i+..�. I Ifiilllillir�
<br /> Existing Use of Building: Med1C11�ff1C0 Contract Price of Work:$ 5�,���
<br /> Proposed Use of Buildin ; Medical Office Heat Source: C�Gas ❑Eiectric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �Commercial ❑Industrial
<br /> T pe of Pro'ect: ❑New ❑Addition �Remodel ❑Repair ❑T.i. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> Minor Interior Alterations-New Finishes
<br /> ASSOCIATED BUILDING PERMIT# if a licable :
<br /> IV�ECHANlCAL�PERIVIIT,E►PPLICI�ITION 'i, ,'° = PL�JM�ING�'.PERMIT APPLICATIOI� ;,'��''� ' '""�ki'"�y��. '
<br /> Type of Project: _New Addn Alteration Repair Type of Project: New Addn _Alteration Repair
<br /> #of List of Fixtures ��f " of Fixtures #9f Lisf of Fixfures #of Lisf of Fia�tures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C—Air Handling Units Heat Pump Toilet Backflo eventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub Ur
<br /> Gas Piping Boiler Lavatory(Wash Basin) rinkin Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes Drye ookups Other: Clothes Washer Medical Gas
<br /> Range Ho Water Heater Other:
<br /> Exhaus an Sink(Servic ar/Mop/etc.) Other:
<br /> �'SP �IK�:E�2[Sk1PP,RESSi�ON�SYST�Wr�'r,"'��u'°. ':
<br /> Chemical or Water No.of Heads
<br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contai ed herein is true and correct.Work done pursuant to this permit must comply with
<br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the
<br /> Building O�cial before being authorized under any circumstance.1 am fhe owner,or 1 am authorized by the owner of this p�operty to perform the work for which application is made,
<br /> and 1 comply with the State Confractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett O�cial Use Only
<br /> C l I 17 PE ( ...
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<br /> Owner/Authorized Agent Signature D te (Revised 9/23/2016)
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